Introduction: Chronic suppurative otitis media (CSOM) is a long-standing infection of middle ear cleft having a permanent perforation in the tympanic membrane with or without discharge. This is usually classified into two main groups: tubotympanic and atticoantral disease. The atticoantral type is called unsafe type because of the associated complications due to granulations and cholesteatoma which may be life-threatening. Tubotympanic type with central perforation is usually not associated with major complications such as cholesteatoma formation. Materials and Methods: This study has been conducted in the Department of ENT, Alluri Sita Rama Raju Academy of Medical Science, Eluru, A.P., India. Study group includes 210 patients having CSOM with central perforations in the tympanic membranes who underwent different types of procedures in our department. Preoperatively, all the patients were evaluated with otoscopy, microscopy, pure-tone audiometry, and some patients with computed tomography scan. All the patients had been evaluated peroperatively for confirmation of preoperative findings under microscope. Results: Surprisingly, seven patients with central perforations were having cholesteatoma, confirmed by biopsy. Conclusion: This study suggests that no perforation in CSOM is safe. Any patient coming for medical advice having CSOM with any type of perforation should be evaluated properly to exclude the underlying pathology like cholesteatoma which may be dangerous later on if not identified.